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Insurers faulted for changing members' plans without consent

Customer called the experience a 'Kafkaesque nightmare'

After canceling individual plans that failed to meet Affordable Care Act requirements, Anthem Blue Cross and Kaiser Permanente switched hundreds of Californians into compliant plans and withdrew premiums from customers' bank accounts for those plans without members' knowledge, ProPublica reported. The California Department of Insurance now is investigating whether the payers acted illegally by collecting payment for products customers never chose.

Anthem notified customers of plan cancelations in letters last fall. The letters said if customers didn't instruct Anthem to do otherwise, the insurer would move them into a compliant plan and continue deducting automatic premium payments for customers who previously arranged them, ProPublica noted. But some customers didn't read the entire letter and bought replacement coverage elsewhere. However, most insurers' cancellation letters told members they would automatically get enrolled in another plan, as the Washington Post pointed out earlier this month.

Problems customers had when trying to cancel automatic payments caused frustration with payers and complaints. The timing could hardly be worse for telephonic resolution of customer problems, since ACA-related complaints and inquiries are straining payer call centers and extending waiting times for frazzled members, FierceHealthPayer reported.

People who failed to inform Anthem of new plan selections either on time or at all will get full refunds, Anthem spokesman Daniel Ng told ProPublica in an email. So will about 500 Kaiser Permanente members in California. "We take this seriously" Kaiser spokesman Chris Stenrud wrote in an email to ProPublica, "and we want to assure our members that we will make them whole."

Nevertheless, the California Department of Insurance is investigating two potential legal violations by insurers in this matter. First, switching customers into new policies may be considered a material change that activates a requirement to tell people how to cancel prior electronic funds transfer agreements, ProPublica noted. Further, some ACA-complaint plans were sold by payers' affiliates with which customers had no prior electronic funds transfer agreements.

For more:
- read the ProPublica article

Related Articles:
ACA-related complaints challenge payers
Survey: Californians lack information about exchanges
Canceled plans provoke lawsuit
Billing problems plague insurers
ACA grace period could leave insurers with unpaid premiums